Thrombocytopenia Associated with Elemental Mercury Poisoning in Two Siblings - Connecticut, July 2022

Abstract

Two siblings aged 5 and 15 years from Connecticut were hospitalized with petechial rash, oral mucositis, and severe thrombocytopenia approximately 10 days after they played with a jar of elemental mercury they found in their home. Before the mercury exposure was disclosed, the siblings were treated with platelet transfusions, intravenous immune globulin (IVIG) for possible immune thrombocytopenic purpura, and antibiotics for possible infectious causes. When their conditions did not improve after 6 days, poison control facilitated further questioning about toxic exposures including mercury, testing for mercury, and chelation with dimercaptosuccinic acid. The older sibling soon recovered, but the younger child required a prolonged hospitalization for severe thrombocytopenia, ultimately receiving repeated doses of IVIG, steroids, and romiplostim, a thrombopoietin receptor agonist. Close collaboration among multiple agencies was required to identify the extent of mercury contamination, evaluate and treat the other family members, and decontaminate the home. These cases demonstrate the importance of ongoing public health outreach to promote early detection of elemental mercury toxicity, and the need to evaluate for environmental exposures when multiple close contacts experience similar signs and symptoms.

FIGURE

Platelet count, blood mercury concentration, and interventions for two siblings, patient A, aged 5 years (A) and patient B, aged 15 years (B) with elemental mercury vapor poisoning resulting from an exposure in the home — Connecticut, July 2022 Abbreviation: IVIG = intravenous immune globulin. * Platelet counts were <2,000 per/μL on hospital day 1 (patient A) and hospital days 1, 2, 4, 5, 6, 7, 8, and 9 (patient B). ^† Blood mercury concentration was measured on only one occasion (hospital day 6) for patient B during hospitalization. ^§ Dimercaptosuccinic acid is a chelating agent; romiplostim is a bone marrow stimulant. ^¶ The x-axis ranges in panels A and B are different. Patient A was discharged on hospital day 46, and patient B was discharged on hospital day 15.